Low self-esteem and menopause: why it happens, and what to do about it

Having a crisis of confidence during menopause? You’re not alone

• Why your self-confidence can take a knock during perimenopause and menopause
• The link between hormone changes and mental health in the menopause
• Strategies to boost self-esteem to help you feel more like yourself

‘My self-esteem wasn’t always that great, now even worse. Just never have a decent day anymore when I just feel good.’

Respondent to Dr Louise Newson’s perimenopause and menopause experiences survey (2022)

Has your confidence dipped at home or work? Once the life and soul of the party, but now avoiding social events? Perhaps negative or undermining thoughts about yourself have popped unhelpfully into your mind?

These could all be signs of low self-esteem, a mood-related symptom many women can experience during the perimenopause and menopause.

In a poll of almost 6,000 women for balance founder Dr Louise Newson’s book, The Definitive Guide to the Perimenopause and Menopause, a number of women cited low self-esteem as an issue.

But what is low self-esteem? Find out how to spot if you have low self-esteem, and what steps can boost your confidence and recapture your sense of self.

Self-esteem explained

Self-esteem (also known as self-confidence) is defined by the mental health charity Mind as how you value and perceive yourself. It’s based on your opinions and beliefs about yourself, which can feel difficult to change.

If your self-esteem is low, it is likely to affect all aspects of your life, so you may notice a negative impact on work, social activities, appetite for exercise, relationships and friendships.

Signs of low self-esteem

Having negative beliefs and thoughts about yourself, being unkind to yourself and finding yourself unable to say no to people can all be signs of low self-esteem. This can mean you end up being overburdened, angry and resentful.

How can menopause affect my self-esteem?

The hormones oestrogen, progesterone and testosterone all fall during the menopause, and this can lead to numerous physical and psychological symptoms. Research has found that women who experience higher frequency, intensity, or number of symptoms are more likely to have greater body image concerns [1]. Self-esteem can also reduce during perimenopause, when hormones levels fluctuate and reduce.

RELATED: Mental health and emotional wellbeing in the perimenopause and menopause

Psychological symptoms

When oestrogen falls, levels of the mood-boosting hormone serotonin fall, while cortisol (the primary stress hormone) rises, which can affect mood and lead to anxiety.

Low mood is lowered may mean you don’t want to socialise as much, do the things you normally enjoy, and can put a strain on your relationships with loved ones.

Low self-esteem can also have an impact in the workplace: brain fog can make you leave doubting your ability and affect work performance. If that sounds familiar, then you aren’t alone. A 2021 survey of 3,800 perimenopausal and menopausal women, 99% of respondents said their perimenopausal or menopausal symptoms had led to a negative impact on their careers; 59% had taken time off work due to their symptoms; 21% passed on the chance to go for a promotion they would otherwise have considered; 19% reduced their hours and 12% resigned [2].

RELATED: How to thrive at work during the menopause

Physical symptoms and self-esteem

In addition, the effects of physical symptoms can also impact self-esteem.

One symptom is weight gain: during perimenopause and menopause, your body tries to combat falling levels of oestrogen by trying to obtain it from elsewhere. One place it looks to is oestrone, a different form of the hormone produced by fat cells called oestrone. Oestrone is less effective than oestradiol (the most beneficial type of oestrogen) and oestrone is inflammatory in your body. Some women can develop a ‘spare tyre’ in response to this and might also have strong cravings for foods high in sugar or unhealthy fats, which the body lays down as oestrone-producing abdominal fat.

Other physical symptoms triggered by hormone changes that can impact self-esteem include hot flushes and night sweats, brittle hair and skin issues such as dry, itchy skin or the emergence of skin issues.

‘Rosacea and acne has begun after a lifetime of good skin,’ one respondent told Dr Louise’s survey.

‘It has really affected my self-esteem.’

RELATED: Skin changes during menopause

Other physical symptoms like joint pains, vaginal dryness or urinary issues might mean you reduce or avoid exercise, which can both lift mood and help maintain a healthy weight.

If you have stopped doing things you enjoyed, either because of physical or psychological perimenopause and menopause-related symptoms, this can also affect your sense of self and identity, especially if you valued those things and felt they were a significant part of who you are.

So it may be one thing, or a number of factors, coming together and pushing down how you perceive yourself.

What about other life factors?

Many women describe a feeling of midlife invisibility, of not being seen by society or at work. Researchers have found women in midlife describe searching for balance and trying to rediscover themselves, while trying to keep on top of many different sources of stress.

This could include divorce, changing family relationships, health problems and deaths of parents, and can all add to the pressures women feel [3].

RELATED: Invisibility and the menopause

What can I do to boost my self-esteem?

Address the cause of menopause-related mood symptoms: HRT is the first-line treatment for the management of menopausal symptoms [4]. If you suspect the cause of symptoms could be perimenopause or menopause, then make an appointment to see a healthcare professional. Having the right dose and type of HRT, often with testosterone, can usually improve symptoms as your low hormone levels will be replaced.

Track your menopausal symptoms: Get a clear picture of the impact of your hormones on how you are feeling by tracking your symptoms. The free balance menopause support app has a symptom tracker where you can track the type, frequency and severity of symptoms, which can be used to build a health report to take to medical appointments.

Get moving: Research has found that menopausal women who exercise have better self- esteem [5]. Return to an activity you have loved in the past or find a new one.

Exercise boosts mood, sleep quality and energy, while reducing stress, depression and many long-term conditions, according to the NHS.

Negative thoughts? Write them down and challenge them: The NHS website suggests jotting down any negative thoughts and then write down some evidence that challenges these negative beliefs. Follow this up by writing positive statements about yourself, and finally good things that other people have to say to you.

Be kind to yourself: Speak to yourself gently, and use the kind of advice that you would give to a friend in a similar situation.

Consider talking therapies: Cognitive behavioural therapy (CBT) is a type of talking therapy which focuses on breaking unhelpful behavioural patterns and behaviours that we adopt in relation to challenges or stressful situations. It is used for a range of mental and physical health conditions and is recommended in the NICE menopause guidelines as being helpful for menopause-related low mood and anxiety.

Low self-esteem at work? Speak to your manager: If your confidence has taken a hit and you’re struggling at work, talk to your manager or, if you feel more comfortable, someone from human resources. Think about what support you need, or if any adjustments at work can help. Make some notes beforehand about what you are finding difficult and the kind of support that could help.

Build a support network: Having someone you trust to speak to can help, according to Mind. Focus on positive relationships and being with people who make you feel good about yourself.

References

1. Vincent. C. et al (2023). Associations between menopause and body image: A systematic review. Women’s Health. 2023;19. doi:10.1177/17455057231209536

2. Balance (2021) ‘Menopause symptoms are killing women’s careers, major survey reveals’

3. Thomas. A.J. et al (2018). The challenges of midlife women: themes from the Seattle midlife Women’s health study. Womens Midlife Health.15;4:8. doi: 10.1186/s40695-018-0039-9.

4. National Institute for Health and Care Excellence (NICE) (2015) Menopause: diagnosis and management

5. Dąbrowska-Galas M, Dąbrowska J (2021). Physical Activity Level and Self-Esteem in Middle-Aged Women. Int J Environ Res Public Health. 8;18(14):7293. doi: 10.3390/ijerph18147293.